Organization
MICHIGAN ENDOSCOPY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRISTIN TRAHEY (ADMINISTRATOR)
(248) 865-6555
Entity
Organization
Contact information
Practice address
30055 NORTHWESTERN HWY, SUITE L-60, FARMINGTON HILLS, MI 48334-3230
(248) 865-6555
(248) 865-6554
Mailing address
30055 NORTHWESTERN HWY STE L-60, FARMINGTON HILLS, MI 48334-3274
(248) 865-6555
(248) 865-6554
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010473
CERTIFICATE OF NEED
MI
01
—
23-C0001045
MEDICARE ASC NUMBER
—
01
—
23389
AAAHC ACCREDITATION
—
01
—
23D1006055
CLIA CERTIFICATE
—
01
—
40373
BCBSMI
MI
01
—
636910
STATE LICENESE
MI
Enumeration date
06/30/2005
Last updated
11/04/2025
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